Convalescent
Depression After A Myocardial Infarction or Heart Surgery

At some period during the recovery from a myocardial infarction,
depression frequently sets in. This may occur as early as 3
to 5 days after the myocardial infarction or surgery, or appear
later after the patient has left the hospital. It has been likened
to the mourning for a loss: in this case a sense of lost potential
or lost physical ability. Generally the depression is transient
and talking about the patient’s concerns may be the best treatment.
A patient’s stress level can be markedly reduced through reassurance
as to the normalcy and transcience of such conditions as physical
weakness and memory lapses and by open discussion of financial
and domestic problems that are worrisome. Authoritative information
can dispel concerns caused by harmful “myths” about cardiac
conditions and aid in adaptive coping by but both patients and
family. It has been pointed out that appropriate information
contributes to the adaptive coping by correcting unrealistic
appraisals of threat, by reducing uncertainty and thus increasing
the sense of control, and by suggesting more appropriate coping
strategies.

At times, the patient may become depressed
after returning home, even if there are no signs during hospitalization.
The symptoms may be manifested by "somatization" with
symptoms such as pain and fatigue instead of or in addition
to mental signs.

If the physician is aware of depression, he
or she can reassure the patient that such feelings are to be
expected and usually pass in a short time. If the patient is
taking medications that tend to aggravate depression such as
cimetidine, methyldopa, guanethidine, reserpine or beta blockers,
modifications in treatment should be considered. No other therapy
may be necessary, but close follow-up is required. Antidepressant
medication or professional psychiatric care may be indicated
in some cases. Participation in a formal rehabilitation program
is frequently helpful. Loss of appetite, insomnia , feelings
of isolation, and general apathy are among the signs that may
indicate serious depression. Pharmacological treatment may be
required for only a few weeks. Ordinarily, if anxiety and depression
that follow bypass surgery or myocardial infarction have not
been resolved by 3 to 6 months, professional psychiatric care
is indicated.

Because of their potential adverse cardiac
effects, it is frequently not desirable to employ the usual
antidepressant agents for six weeks after bypass procedure or
myocardial infarction or for a patient having arrhythmias. Actually,
it is rare for such patients to suffer a severe endogenous depression
- the sort in which they lose their serotonin and norepinephrine,
the neurotransmitters help control normal mode - in the
first six weeks. In such patients alprazolam can be helpful,especially
if the patient displays a lot of anxiety, as is often the case.
It appears to be as effective as imipramine and to produce its
effect faster.

The patient’s family or "significant
other" also may require help to deal with the stress of
the situation, which usually involves heightened responsibilitie
as well as care of an agitated patient. The crisis situation
of the heart attack or the cardiac surgery and the resulting
role changes and stresses can unleash emotional problems up
to two years later and may have an adverse affect on relationships.

Although cardiac rehabilitation programs
are usually thought of as primarily exercise programs, they
also offer psychological benefits that tend to help resolve
transient depression. With many special medical conditions,
other patients who have been through the experience can provide
meaningful psychological support. There is empathy among the
members and they encourage each other. Patients who have participated
in a comphrehensive rehabilitation program for more likely to
return to work and to report more satisfactory quality of life.
Patients who are deemed ineligible for an exercise program may
be the ones needing more psychological counseling.